Equality of opportunity in health care: access and equal access revisited

We offer a framework for identifying disparities in the distribution of healthcare opportunities. In line with the Rawlsian tradition of fair equality of opportunity, we argue that these have to be primarily defined in terms of access to a (bundle of) health services of appropriate quality. Our approach allows to disentangle the opportunities individuals enjoy—assessed by jointly considering chances of access and disparities in access conditions—from the mere utilization of health services while preserving normative consistency with the principle of equal (access to) health care for those in equal need of health care. A simple exercise based on real data shows that the definition we provide can be easily applied to gather policy-relevant insights.